1780902494 NPI number — NICOLE THERESA CACHO D.O.

Table of content: NICOLE THERESA CACHO D.O. (NPI 1780902494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780902494 NPI number — NICOLE THERESA CACHO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CACHO
Provider First Name:
NICOLE
Provider Middle Name:
THERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780902494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UF DIVISION OF NEONATOLOGY
Provider Second Line Business Mailing Address:
P.O. BOX 100296
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-8985
Provider Business Mailing Address Fax Number:
352-273-9054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER ROAD
Provider Second Line Business Practice Location Address:
SHANDS HOSPITAL
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-8985
Provider Business Practice Location Address Fax Number:
352-273-9054
Provider Enumeration Date:
05/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  UO2347 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: OS12231 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017856600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".